Adult Medicaid Manual MA-2150 MEDICAID-WORKING DISABLED

III. M-WD SPECIAL REQUIREMENTS

A. Limited Coverage

M-WD covers the Medicare A premium (hospital insurance) only. If the individual wants Part B (medical insurance), he must pay for it.

B. Application Processing Requirements

1. Obtain applicant’s signature on the DSS-8124 or the DMA-5008. Complete the DMA-5008. Do not enter a DSS-8124 into EIS.

2. The time standard for M-WD application is 45 days. Manually track and follow processing requirements in MA-2300 through MA-2304.

(III.)

C. Disabled Working Status

SSA must verify Disabled Working status.

D. Disposition

NOTE: M-WD cases will not be entered into EIS. Once the county dss determines eligibility each case will be manually processed at DMA.

1. If the a/r is eligible, approve M-WD and send a DSS-8108. On the DSS-8108 write “You meet the N.C. eligibility requirements for M-WD and are eligible to have the State pay your Medicare Part A premiums.”

2. Once eligibility has been established, send a cover letter within 5 work days to DMA providing the following information on the individual:

a. Full name

b. Medicare number

c. Date of birth

d. Sex

e. Medicare Part A Premium enrollment date

f. SSA Disabled Working status notification letter

3. Send to:

Attn: Supervisor

Claims Analysis Unit

Division of Medical Assistance

2501 Mail Service Center #19

Raleigh, N.C. 27699-2501

E. Retroactive Coverage

If the individual meets the eligibility criteria prior to the month of application, he may be eligible for retroactive coverage for up to 3 prior months provided he has enrolled timely at SSA.

F. Reviews

1. Since this program is not in EIS, the county dss must initiate a review notice and send the appointment letter prior to expiration of the certification period.

2. Send DMA a copy of the notice if ongoing eligibility continues.

G. Termination

If the recipient becomes ineligible, terminate the case and notify DMA.